The report of a study comparing the physical and mental health, perceived quality of life, and health service use among homeless illicit drug users and homeless non-drug users was recently published.1 The cross-sectional study was conducted with 105 participants, all of whom were recruited through Safetynet Ireland. Safetynet operates 14 clinics across Dublin, located in homeless shelters and foodhalls, which provide free primary care services, including access to GPs, nurses and drug workers, in an environment that is accessible to those who are homeless or at risk of homelessness. Study participants were recruited at four of these clinics using a gatekeeper mechanism whereby the patient was informed of the study by a staff member and, if willing to be involved, they were then introduced to the researchers.

A questionnaire consisting of 133 items was used. It included standardised tools such as AUDIT-C to measure problem drinking, GAD-7 for anxiety and PHQ-9 for depression. Quality of life was assessed using the five-point scale from the SLÁN study.2 Participants were also asked if they were current, previous or never illicit drug users. Logistic regression was used to determine if drug use was associated with multimorbidity, anxiety and/or depression, poorer perceived quality of life or increased use of health services. Age, gender, alcohol use and smoking were also considered.

Of the 105 participants, 35 were current illicit drug users and 28 had used drugs in the past. The majority (75%) were male and 58% were under 40 years of age. The main accommodation type was hostel (43%) and 60% had been in their current accommodation for between 1 and 12 months. The demographic characteristics were similar for both drug and non-drug users, except that a higher proportion of current drug users as opposed to non-drug users were Irish (82% vs 70%) and were more likely to be current alcohol drinkers (94% vs 58%); fewer current drug users had completed third-level education (3% vs 13%).

The majority of participants (82%) were smokers. Of the 35 current illicit drug users, 21 (60%) were currently injecting one or more drugs intravenously, primarily heroin (95%), and had injected on average on 61 of the previous 90 days. Of the 21 injecting drug users, 81% reused their own needle/syringe and 66% shared another drug user’s needle/syringe. Almost all (n=20) had used needle exchange services in the previous six months. Polydrug use was reported by 34% of all illicit drug users.

Six per cent of participants were HIV positive and this rose to 9% among current drug users. Moreover, 37% of illicit drug users were positive for hepatitis C (23% of all participants) and 3% were positive for hepatitis B. Eighty per cent of illicit drug users had been tested for HIV and hepatitis B and C. Current and previous drug users were five times more likely to have multimorbidity than those who had never taken drugs. Current drug users were four times more likely to report poor perceived quality of life than non-drug users, while there was no difference between non-drug users and previous drug users.

Uptake of primary care services was high among all participants. GP services were used by 86% of illicit drug users and Safetynet nurses by 71%. A total of 46% of current drug users were using methadone, while a further 11% were on the waiting list for methadone treatment. Current drug users were less likely to avail of mental health or dental services than those who did not use illicit drugs.

The authors highlight the high level of drug use among the homeless population and the negative impact this has on their health and perceived quality of life. They illustrate the importance of services such as Safetynet in providing accessible primary care services which meet the specific health needs of this population.

1 O'Brien KK, Schuttke A, Alhakeem A, Donnelly-Swift E, Keogh C, O'Carroll A, O'Sullivan K, Galvin R and Fahey T (2015) Health, perceived quality of life and health services use among homeless illicit drug users. Drug and Alcohol Dependence, 154: 139–145. https://www.drugsandalcohol.ie/24384/

2 SLÁN (Survey on Lifestyle and Attitude to Nutrition) is a four-yearly survey commissioned by the Department of Health and designed to produce baseline information for the ongoing surveillance of health and lifestyle behaviours in the Irish population. For further information, visit http://www.ucd.ie/issda/data/surveyonlifestyleandattitudestonutritionslan/